| National Provider Identifier [NPI]: | 1891777371 |
| Last Name Of The Provider | TIBBETTS |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D., PH.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8401 DATAPOINT DR |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295900 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 61031 |
| Number Of Medicare Beneficiaries | 3169 |
| Total Submitted Charge Amount | 2807193.38 |
| Total Medicare Allowed Amount | 740822.79 |
| Total Medicare Payment Amount | 574528.82 |
| Total Medicare Standardized Payment Amount | 618565.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 56505 |
| Number Of Medicare Beneficiaries With Drug Services | 607 |
| Total Drug Submitted ChargeAmount | 36409 |
| Total Drug Medicare AllowedAmount | 14638.55 |
| Total Drug Medicare PaymentAmount | 11226.03 |
| Total Drug Medicare Standardized Payment Amount | 11226.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 172 |
| Number Of Medical Services | 4526 |
| Number Of Medicare Beneficiaries With Medical Services | 3169 |
| Total Medical Submitted Charge Amount | 2770784.38 |
| Total Medical Medicare Allowed Amount | 726184.24 |
| Total Medical Medicare Payment Amount | 563302.79 |
| Total Medical Medicare Standardized Payment Amount | 607339.53 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 525 |
| Number Of Beneficiaries Age 65 to 74 | 1250 |
| Number Of Beneficiaries Age 75 to 84 | 967 |
| Number Of Beneficiaries Age Greater 84 | 427 |
| Number Of Female Beneficiaries | 1752 |
| Number Of Male Beneficiaries | 1417 |
| Number Of Non Hispanic White Beneficiaries | 1966 |
| Number Of Black or African American Beneficiaries | 132 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 1011 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2459 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 710 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.1108 |